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The Two-bag System for Intravenous Fluid Management of Children with Diabetic Ketoacidosis: Experience from a

Rashed A Hasan1, Kewan Hamid2, Donald Dubre3

  • 1St Vincent Mercy Children's Hospital, Toledo, OH, USA.

Global Pediatric Health
|February 22, 2021
PubMed

Insights

The two-bag system for intravenous fluid in pediatric diabetic ketoacidosis (DKA) showed lower resource use but increased hypoglycemia risk compared to the one-bag system. Further research is needed for optimal DKA management.

Area of Science:

  • Pediatric Endocrinology
  • Critical Care Medicine
  • Metabolic Disorders

Background:

  • Diabetic ketoacidosis (DKA) is a serious complication of diabetes in children.
  • Intravenous fluid (IVF) management is crucial for DKA treatment.
  • Different IVF administration systems exist, including one-bag and two-bag methods.

Purpose of the Study:

  • To compare the effectiveness and safety of the two-bag versus one-bag IVF system in pediatric DKA patients.
  • To evaluate resource utilization and clinical outcomes associated with each IVF system.

Main Methods:

  • Retrospective cohort study design.
  • Inclusion of 109 pediatric patients with DKA admitted between January 2015 and December 2016.
  • Comparison of demographic and laboratory data, resource utilization (calls, IVF bags, fluid boluses), and clinical outcomes (hypoglycemia, hospital/PICU stay).

Main Results:

  • The two-bag system was associated with significantly fewer calls (25.2 vs 5.2, P=.0001).
  • The one-bag system showed fewer instances of hypoglycemia (<60 mg/dL) (4 vs 12, P=.049).
  • No significant differences were observed in glucose drop rate, IVF bags used, fluid boluses, or length of hospital/PICU stay.

Conclusions:

  • The two-bag IVF system demonstrates reduced resource utilization and a slower blood glucose drop rate in pediatric DKA.
  • However, the two-bag system is linked to a higher incidence of hypoglycemic events.
  • Clinical decisions regarding IVF administration in pediatric DKA should weigh these trade-offs.

Keywords:
diabetic ketoacidosisfluidtwo bag

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